Provider First Line Business Practice Location Address: 
2002 HOLCOMBE BLVD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HOUSTON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77030-4211
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
713-791-1414
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/13/2011